Judge defers decision on care for catastrophically injured boy

The president of the High Court has agreed to a deferral of her decision to permit a hospital withhold invasive interventions should the condition of a catastrophically injured boy deteriorate.

Such a move would effectively see the hospital begin to administer a palliative care regime,

The boy's mother, who opposes the orders sought, had tears in her eyes and clutched a set of rosary beads as her counsel Siobhan Phelan SC appealed to Ms Justice Mary Irvine, as the judge was about to give judgment on Friday afternoon.

Ms Phelan urged the judge to defer it in light of what counsel described as “very significant” new reports from the hospital on the boy’s condition.

Represented by Colin Smith BL, the boy’s father, who is estranged from the mother, supported an adjournment.

Conor Dignam SC, for the hospital, disagreed the reports indicated any significant change in the boy’s condition but said they may be relevant to the court’s consideration of his constitutional rights.

While having “no principled objection” to an adjournment, counsel stressed there is urgency because the type of crisis doctors feared in this case could happen any time and they would have to respond to it

Ms Justice Irvine said, among the factors she has to decide, is what the boy himself, in his current state of affairs, would want if he could tell the court. Her principal concern was to have all the evidence before delivering her final decision.

One doctor had told the court the boy’s case was the worst case of dystonia she had seen in nine years of dealing with hundreds of such patients in a busy London hospital, while another doctor had said it “verged on cruelty”, the judge noted. While very anxious about the time frame in this matter, Ms Justice Irvine said she was also very anxious to respect the boy’s right to life.

She considered the “just, fair and correct thing to do” was to adjourn to next Wednesday to hear more evidence from doctors and submissions after which she would deliver judgment as speedily as possible.

Potential for litigation

The application for the orders arose after the boy suffered catastrophic injuries in a road collision in early summer.

The judge previously granted the hospital’s initial application, brought in light of the clash of views between the parents and doctors on treatment, to have him made a ward of court. Both parents opposed wardship the effect of which is that the court will determine what is in the boy’s best interests.

During the hearing, a palliative critical care specialist said doctors had concerns about the potential for litigation given the disagreement with the parents about the treatment options for the boy and indicated that was among the reasons the orders were being sought.

The hospital says doctors agree the boy is almost certainly in pain as a result of dystonic episodes, his dystonia will be lifelong and he will make no meaningful recovery from his injuries. One doctor considered his best prognosis was to move from a vegetative state to a minimally conscious state.

Elizabeth Murphy SC, for the mother, opposed the application as “unprecedented” and premature, arguing it was made without an opportunity to adequately diagnose his recovery prospects from his injuries.

On Friday, as the judge was about to give judgment, Ms Phelan, also for the mother, said new reports received from the hospital on Thursday night indicated a “very significant” change in the boy’s condition.

He had not required respiratory medications for his dystonia since September 29th last when he previously appeared to have required such treatment for dystonia on a daily basis, counsel said.

The reports also said a chair has been ordered for the boy, which had to be seen in the context of evidence that he would remain bedridden, she said. She asked for time to consider the reports.

The judge noted the reports do not say his dystonia is not continuing but that he does not require respiratory medications for it as often as he had and that dystonia is not currently interfering with daily living activities such as dressing and bathing.

David Leahy BL, for the boy’s court-appointed guardian, said it did not appear the reports indicated any change in the trajectory of the child’s condition. If the court made the orders, his treatment would remain the same except that clinicians would be permitted not to escalate interventions if they considered those not in his best interests, counsel said.